The insertion of tubular medical devices into human bodies has always presented problems. Forcing tubes through a convoluted path to reach various body organs is difficult in a surgical setting while the patient is sedated and prepared for the insertion.
However, on many occasions the necessity for intubation arises during an emergency when the patient is in an hypoxic or other distressed condition. Because the personnel of emergency rooms and rescue vehicles are not expert at the insertion of intubation tubes into the trachea, the intubation tube may be misplaced in the esophagus, or may cause trauma to tissue. In the instance of an attempted endotracheal intubation, a common complication during intubation in the insertion of the intubation tube into the esophagus rather than the tracheal passage. If this mistake has been made, and pressurized air in forced through the endotracheal tube down the esophagus, the contents of the stomach are forced back up and may enter the lungs, doing severe damage to the tissue.
To perform an oral intubation, a laryngoscope is generally used to provide the operator with a view of the vocal cords. The intubation tube must be curved anteriorly through the vocal cords and inserted into the trachea. Because this is such a precise operation, it is preferable that the patient be absolutely still. This is nearly impossible, considering the patient will probably experience a retch response to the oral insertion of the laryngoscope. Further complications occur among patients who have a deformity of the neck or throat or other conditions such as diseased tissue which would impede the insertion of something down the throat. For such patients, intubation under ideal conditions is difficult at best. Under emergency conditions, such as cardiopulmonary resuscitation it is difficult to perform an intubation because the patient is jostled, rendering the larynx a moving target. In such situations, it is imperative to have a method of insertion for the intubation tube which is quick, reliable, and effective.
During emergency circumstances, such as cardiopulmonary resuscitation, fluid such as mucus or vomitus, may be present in the tracheal passage due to ventilation. Ventilation is accomplished with a mask and a bag to squeeze air into the lungs. As the mask is placed over the nose and mouth, both the lungs and the stomach are inflated and the fluids in both those body cavities are displaced. The situation further departs from the ideal controlled intubation because in an emergency the patient is usually hypoxic at the outset.
During cardiopulmonary resuscitation, the intubation may be attempted several times, and those efforts interrupted with bag and mask ventilation to provide much needed oxygen to the patient. At this point, there are two objectives for the operator of the intubation to achieve:
1. clearing the oropharynx of secretions so that the operator can see the vocal cords; and PA1 2. intubating into the trachea as quickly as possible between the vocal cords.
If too long an interval passes without success during attempted intubation, mask and bag ventilation must be resumed before intubation is attempted once again. Generally, a human brain will endure about five minutes of an anoxic state before brain damage begins. Therefore, this entire operation must be performed speedily and with a high degree of accuracy. As emergency personnel are not necessarily experts at intubation, a method is needed to provide speedy, reliable and effective insertion of an intubation tube to supply oxygen to the lungs.
In a second situation, the lungs of a patient may require suctioning of copious secretions which the patients cannot clear effectively by coughing. Conventionally, these patients have a soft catheter inserted intranasally, but this is uncomfortable and may cause trauma to tissues. The same problem as described before arises because entry into the tracheal passage is not assured. Current alternatives to this practice include the insertion of a nasopharyngeal airway, which is left in place in the nostril. This method spares the patient the discomfort of constant removal and insertion of a catheter, but the problem of inserting the catheter into the trachea remains.
Additionally, it would be advantageous to have a disposable medical device which could selectively suction either main stem bronchus of the lung for sample taking purposes. The problem arises from the inability to precisely insert a suctioning device into a selected body cavity.
And yet a further problem is presented when specimens of fluid must be removed from the lungs when a patient is suspected to have pneumonia. Immediate microscopy and staining may suggest antibiotics to be administered to prevent further damage to the lungs of the patient. Traditionally, if a patient could not produce a specimen by coughing, he was given a mist to breathe to loosen the secretions prior to repetition of the coughing action. Conventional soft nasal suction catheters may be attached to a sputum trap. An attachment, the suction stylet, fitted to a sputum trap for withdrawing specimens discharged from the surface of respiratory passages would permit effective specimen-taking for problem patients.
An endotracheal tube, as disclosed in U.S. Pat. No. 4,063,561 issued on Dec. 20, 1977, includes therein metallic material within the walls of the tube to be influenced by external magnetic devices placed over the larynx of the patient externally. Because the trachea is anterior to the esophagus in a patient, the tip of the endotracheal tube is to be drawn by the external magnetic device into line with the trachea and inserted therein.
Another endotracheal control device as disclosed in U.S. Pat. No. 4,244,362 issued on Jan. 13, 1981, goes further by disclosing a first magnetic means attached to one end of the stylet and a second magnetic means for external placement over the tracheal orifice of a patient. The first magnetic means is reusable.